Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening

Background: Children with congenital hearing impairment benefit
from early detection and management of their hearing loss. These
and related considerations led to the recommendation of universal
newborn hearing screening. In 2001 the first phase of a national
Newborn Hearing Screening Programme (NHSP) was implemented in
England. Objective of this study was to assess costs and
effectiveness for hospital and community-based newborn hearing
screening systems in England based on data from this first phase
with regard to the effects of alterations to parameter values.
Methods: Design: Clinical effectiveness analysis using a Markov
Model. Outcome measure: quality weighted detected child months
(QCM). Results: Both hospital and community programmes yielded 794
QCM at the age of 6 months with total costs of 3,690,000 pound per
100,000 screened children in hospital and 3,340,000 pound in
community. Simulated costs would be lower in hospital in 48% of the
trials. Any statistically significant difference between hospital
and community in prevalence, test sensitivity, test specificity and
costs would result in significant differences in cost-effectiveness
between hospital and community. Conclusion: This modelling exercise
informs decision makers by a quantitative projection of available
data and the explicit and transparent statements about assumptions
and the degree of uncertainty. Further evaluation of the
cost-effectiveness should focus on the potential differences in
test parameters and prevalence in these two settings.